BACKGROUND The prevalence and severity of noncommunicable chronic diseases(NCDs)among Chinese residents have been increasing with mental health emerging as a critical challenge in disease management.AIM To examine the...BACKGROUND The prevalence and severity of noncommunicable chronic diseases(NCDs)among Chinese residents have been increasing with mental health emerging as a critical challenge in disease management.AIM To examine the interactions between depression,anxiety symptoms,and related factors,and to identify key factors in the Chinese population with NCDs.METHODS Data from the Psychology and Behavior Investigation of Chinese Residents were used in a cross-sectional survey of 6182 individuals with NCDs.This study measured depression and anxiety symptoms as well as their influencing factorsincluding social environments,individual behaviors and lifestyles,and subjective indicators.A network analysis approach was used for data assessment.RESULTS Network analysis demonstrated that several central factors(media exposure,family health,problematic internet use,suboptimal health status,intimate relationship violence,tired or little energy,and nervousness/anxious/on edge)and bridge factors(media exposure,problematic internet use,intimate partner violence,health literacy,and suboptimal health status)that significantly influenced the co-occurrence and interconnectedness of depression and anxiety symptoms.Additionally,gender,ethnicity,residency,and living status did not significantly influence the overall network strength.CONCLUSION Depression and anxiety are prevalent among the Chinese population with NCDs.Effective interventions should focus on managing key symptoms,promoting correct media use for health information,and fostering healthier family relationships.展开更多
The purpose of this article is to briefly introduce the status and challenges of major noncommunicable diseases （mNCDs）, which include cardiovascular disease, diabetes and cancer, as well as related risk factors, su...The purpose of this article is to briefly introduce the status and challenges of major noncommunicable diseases （mNCDs）, which include cardiovascular disease, diabetes and cancer, as well as related risk factors, such as environmental pollution, smoking, obesity and sleep disorders. ＂S-E-E-D＂ rules or the strategies of ＂S-E-E-D＂ intervention （SEEDi） consist of four core healthy elements： sleep, emotion, exercise and diet. The history of SEEDi1.0-3.0 is also introduced, which includes versions 1.0, 1.5, 2.0 and 3.0 of the program. These guidelines are suitable for prevention and control of mNCDs. Not only the ＂Healthy China＂ initiated in China＇s ＂13th Five-year Plan,＂ but also the ＂Healthy World＂ philosophy needs SEEDi1.0-3.0 strategies for control of mNCDs.展开更多
High blood pressure and other non-communicable diseases associated with excessive salt/sodium consumption represent a major challenge to the health of the world’s population. Consumption is a human behavior that is u...High blood pressure and other non-communicable diseases associated with excessive salt/sodium consumption represent a major challenge to the health of the world’s population. Consumption is a human behavior that is usually influenced by significant factors, internal and external to people. The design of a national social marketing intervention is described. The whole process was developed by a national interdisciplinary team over the course of a decade (2011-2022). Its purpose is to promote changes in this behavior, through gradual reduction of salt/sodium consumption in the target populations of Costa Rica, for the prevention and control of associated diseases. The process includes four phases: research, situation analysis, creation of a proposal for the social marketing strategy, and implementation and evaluation. Last phase was not developed by the research team. The main inputs used to design this intervention were the data generated in three qualitative researchers carried out by the national work team and the social marketing regional plan for salt consumption reduction in Latin America. By analyzing these research data, marketing mix components were determined for designing the intervention. The marketing strategy is promotional and is based on encouraging a natural diet with less sodium using natural seasonings and adding less discretional salt and industrialized products high in sodium, in the preparation of food and dishes. The primary key audience is the mother of the school-aged child, and the secondary is the adult caregivers of this child. It is expected that in the short term, health promoters from different government and non-state sectors will contribute to the implementation of the national social marketing plan, to achieve, in the medium or long term, a consumption that approaches five grams of salt per person per day. This plan is a country initiative to position the value of a natural diet with less sodium and to contribute to the prevention and treatment of HT and NCD associated diseases.展开更多
1|BACKGROUND Noncommunicable diseases(NCDs)are a significant public concern,greatly impacting the economic and social development in China.In 2019,NCDs accounted for a staggering 88.5%of total deaths in China,with car...1|BACKGROUND Noncommunicable diseases(NCDs)are a significant public concern,greatly impacting the economic and social development in China.In 2019,NCDs accounted for a staggering 88.5%of total deaths in China,with cardiovas-cular diseases,cancer,chronic respiratory diseases,and diabetes—the four major chronic diseases—contributing to a premature mortality rate of 16.5%[1].The complexity of NCDs arises from the involvement of multiple genetic and environmental factors that interact in intricate ways.The complexity is characterized by a multitude of interactions among genes,proteins,and metabolic path-ways throughout the various stages of life.展开更多
In May 2022,the 75th World Health Assembly recognized the need to accelerate national responses to the growing burden of noncommunicable diseases(NCDs)to achieve the goals of the Global Action Plan(GAP)for the Prevent...In May 2022,the 75th World Health Assembly recognized the need to accelerate national responses to the growing burden of noncommunicable diseases(NCDs)to achieve the goals of the Global Action Plan(GAP)for the Prevention and Control of NCDs.To facilitate this,an implementation roadmap was adopted that urges countries to prioritize the implementation of NCD interventions that are most appropriate to their specific local and regional context.The roadmap will act as an overarching guide for countries to tackle NCDs via three approaches:(i)Accelerate national responses based on local NCD epidemiology,risk factors and identified barriers and enablers;(ii)Prioritize and scale up the implementation of most impactful and feasible interventions according to the local context;and(iii)Ensure timely,reliable and sustained national data on NCD risk factors and mortality for data driven actions and to strengthen accountability[1].展开更多
Background:Noncommunicable diseases(NCDs)are public health threats globally and recognized impediments to socioeconomic development.This study aimed to identify the prevalence and clustering of NCDs risk factors among...Background:Noncommunicable diseases(NCDs)are public health threats globally and recognized impediments to socioeconomic development.This study aimed to identify the prevalence and clustering of NCDs risk factors among Bangladeshi men and women aged 20-59 years using nationally representative data.Methods:This study was conducted in 82 rural,nonslum urban,and slum clusters across all eight administrative divisions of Bangladesh using multistage cluster sampling.A total of 4917 men and 4905 women aged 20-59 years were included in the study.Descriptive analyses were performed to report the prevalence and distribution of behavioral and clinical risk factors.Multivariable binary logistic regression was performed to identify factors associated with the coexistence of three or more NCD risk factors.Results:The prevalence of tobacco use(any form),insufficient physical activity,inadequate fruit and vegetable consumption,overweight and obesity,and central obesity were 38.3%,13.6%,87.1%,42.3%,and 36.0%,respectively.Furthermore,21.9%and 4.9%participants had hypertension and self-reported diabetes,respectively.Regarding the clustering of risk factors,37.1%men and 50.8%women had at least three NCD risk factors.Only 3.0%men and 1.8%women reported no NCD risk factors.Age,place of residence,education,and wealth status were associated with the presence of at least three risk factors for both sexes.Conclusion:Since a large proportion of Bangladeshi 20-59 years old population had multiple risk factors,population-based programs with multisectoral approaches are essential to reduce NCDs among Bangladeshi women and men.展开更多
Background Noncommunicable diseases(NCDs)are the main reasons of mortality worldwide.One of every two person is dying due to NCDs in Afghanistan.International policy actors,mainly the World Health Organization(WHO),pu...Background Noncommunicable diseases(NCDs)are the main reasons of mortality worldwide.One of every two person is dying due to NCDs in Afghanistan.International policy actors,mainly the World Health Organization(WHO),published several reports and declarations on controlling and preventing NCDs.This study aimed to provide a situation for governance of NCDs in Afghanistan and proper solutions for identified challenges.Methods We conducted qualitative research utilizing interpretive phenomenology.A self-developed questionnaire was developed to conduct the semi-structured interviews with 39 experts from Afghanistan.The results were analyzed using a deductive framework analysis.Six building block framework of health system developed by the WHO was used as predefined framework for this study.Results The governance building block of health system consists of five subthemes including policy making,planning,organizing,stewardship,and control.We identified main strengths,weaknesses,opportunities,and challenges for these subthemes.The experts also provided key recommendations to address the challenges.Conclusions Management of NCDs is a neglected part of the health system in Afghanistan.Strengthening evidence-based policy making with technical and indigenous planning,establishing responsive units with adequate financial and human resources within different ministries to address“health in all policies”concept,passing and implementing national laws and regulations to support national strategies for prevention and control of NCDs,and establishing decentralized monitoring systems to control the implementation of these strategies are the main recommendations of this study.Local government and international policy actors should invest and support the development of a multisectoral coordination system at national level for Afghanistan.展开更多
Background:Disease epidemiology encompasses a wide range of health conditions,divided into communicable and noncommunicable diseases.Aim and Objective:This systematic review investigates the intricate connection betwe...Background:Disease epidemiology encompasses a wide range of health conditions,divided into communicable and noncommunicable diseases.Aim and Objective:This systematic review investigates the intricate connection between genetic susceptibility and disease development within these categories.Understanding genetic factors is crucial for improving prevention,diagnosis,and treatment strategies.The central research question is as follows:Which genes are linked to susceptibility to communicable and noncommunicable diseases,and how do these genetic elements affect susceptibility?We hypothesize that an exhaustive analysis of the literature will reveal numerous genes associated with both types of diseases,revealing the complex genetic landscape influencing susceptibility.Methodology:This systematic review follows a rigorous methodology,including comprehensive search strategies,well-defined inclusion and exclusion criteria,publication bias assessment,data extraction,quality evaluation,and data synthesis,adhering to PRISMA(Preferred Reporting Items for Systematic Reviews and Meta-Analyses)guidelines to ensure transparency and ethical presentation.Several databases,including PubMed,Embase,Springer Nature,AJOL,CrossRef,Scopus,and Web of Science,were systematically searched to retrieve published articles.Findings:In communicable diseases,the genetic factors influencing susceptibility extend beyond well-established genes,warranting further investigation under conditions such as COVID-19,HIV,tuberculosis,and hepatitis B.Noncommunicable diseases,such as cardiovascular diseases,cancer,neurological disorders,and metabolic disorders,offer promising avenues for exploring additional genetic variations.Research gaps include understanding the functional impact of the identified polymorphisms,their interaction with environmental factors,and their implications for rare diseases.Conclusion:Genome-wide association studies and gene editing therapies have the potential to expand our understanding and therapeutic options for genetically based diseases.This comprehensive review contributes to the evolving landscape of genetic susceptibility and its implications for public health and personalized medicine.展开更多
Chronic diseases,or NCDs(noncommunicable diseases),constitute a major global health challenge,causing millions of deaths and imposing substantial economic burdens annually.This paper introduces the Health Score,a comp...Chronic diseases,or NCDs(noncommunicable diseases),constitute a major global health challenge,causing millions of deaths and imposing substantial economic burdens annually.This paper introduces the Health Score,a comprehensive framework for assessing chronic disease risk by integrating diverse determinants of health,including social,economic,environmental,behavioral,treatment,culture,and nature factors.The Health Score,ranging from 0 to 850,quantifies indivi dual and population-level health risks while identifying protective factors through a structured methodology that supports targeted interventions at individual,corporate,and community scales.The paper highlights the rising prevalence of chronic diseases in the United States,projecting that nearly half of the population will be affected by 2030,alongside a global economic burden expected to reach trillions of dollars.Existing surveillance tools,such as the CDS(Chronic Disease Score)and CDIs(Chronic Disease Indicators),are examined for their roles in monitoring health disparities.The Health Score advances a holistic,proactive approach,emphasizing lifestyle modifications,equitable healthcare access,economic opportunities,social support,nature exposure,cu ltural awareness,and community engagement.By elucidating the complex interplay of health determinants,this framework equips stakeholders with actionable insights to implement effective prevention strategies,ultimately fostering healthier,more resi lient populations.展开更多
Background:Afghanistan is suffering from 40-year chronic conflicts,displacement,and demolition of its infrastructure.Afghanistan mortality survey 2010 shows nearly 46%of all deaths in the country were attributed to no...Background:Afghanistan is suffering from 40-year chronic conflicts,displacement,and demolition of its infrastructure.Afghanistan mortality survey 2010 shows nearly 46%of all deaths in the country were attributed to noncommunicable diseases(NCDs).In this study,we aimed to understand the differences in mortality and premature death due to NCDs by sex and the trend for the next 8 years.Methods:We applied trend analysis using the secondary data from the Institute for Health Metrics and Evaluation,Global Burden of Diseases 2019.The information on NCD mortality,NCD deaths attributed to its risk factors,NCD percent of total years lived with disability(YLDs)attribution to each risk factor extracted from this database from 2008 to 2019.We investigated the trend from 2008 to 2019 for the mentioned factors and then forecast their trends until 2030.Results:Our study shows that Afghanistan has had an increasing death number due to NCDs from 2008 to 2019(50%for both sexes)and this will reach nearly 54%by 2030.Currently,half of NCDs deaths are premature in Afghanistan.The mortality rate and prevalence of risk factors are higher among women.More than 70%of YLDs will be due to NCDs in Afghanistan till 2030.Five risk factors including high systolic blood pressure(28.3%),high body mass index(23.4%),high blood glucose(20.6%),high low-density lipoprotein cholesterol(16.3%),and smoking(12.3%)will have the highest contribution to NCDs death in 2030,respectively.Conclusions:In general,our study indicates that without any specific intervention to address NCDs in Afghanistan,not only the Sustainable Development Goal target for NCDs will not be met,but an increase in almost all risk factors prevalence,as well as NCD mortality,will be seen in Afghanistan.展开更多
Background:Noncommunicable diseases(NCDs)are the leading cause of morbidity and mortality worldwide.The aim of this study was to determine the prevalence of NCDs among the population of Cyprus and to identify the dist...Background:Noncommunicable diseases(NCDs)are the leading cause of morbidity and mortality worldwide.The aim of this study was to determine the prevalence of NCDs among the population of Cyprus and to identify the distribution of the socioeconomic and demographic determinants among individuals with the most frequent NCDs.Methods:A cross-sectional study was conducted using stratified sampling.Socioeconomic and demographic characteristics and the presence of NCDs were collected through a standardized questionnaire.The diseases were classified using the 10th revision of the International Classification of Diseases(ICD-10).Results:In total,1140 individuals participated in the study,among whom 590(51.7%)had at least one chronic disease.The most prevalent NCDs were hyperlipidemia(17.4%),hypertension(12.9%),and thyroid diseases(8.4%).We identified more males than females with hyperlipidemia aged 25–44 years old and>65 years old(p=0.024),more males compared to females with hypertension(p=0.001)and more females compared to males with thyroid diseases(p<0.001).Individuals with hypertension and hyperlipidemia were more likely to be married,to have completed a higher education,and to have a high annual income.Discussion:In Cyprus,the majority of the general population had at least one NCD.Hyperlipidemia,hypertension,and thyroid disease are relatively common,even at younger ages,highlighting the need for the development of public health programs aimed at addressing and preventing NCDs.展开更多
Background:Noncommunicable diseases(NCDs)place a heavy burden on populations globally and in particular,on lower-income countries(LIC).WHO identified a package of 16“best buy”lifestyle and management interventions t...Background:Noncommunicable diseases(NCDs)place a heavy burden on populations globally and in particular,on lower-income countries(LIC).WHO identified a package of 16“best buy”lifestyle and management interventions that are cost-effective and applicable in all settings.The purpose of this study was to evaluate and compare NCD risk factors in all WHO countries and make preliminary assessment of“best buy”interventions.Methods:Risk factors estimation was made in 188 countries.NCD attributable“best buys”concern tobacco use,unhealthy diet,physical inactivity,and harmful use of alcohol.Management issues are based on the availability of the national NCD guidelines and provision of drug therapy.Results:Every fourth adult in high-income countries(HIC)has raised blood pressure(RBP).Prevalence of RBP in lower-middle-income countries(LMIC)and LIC is 22%–23%(HIC/LMIC:t=3.12,p<0.01).Prevalence of diabetes in LIC is less than half of that in HIC and upper-middle-income countries(UMIC)UMIC/LIC:t=8.37,p<0.001.Obesity prevalence is gradually decreasing from HIC to LIC(HIC/LIC:t=11.48,p<0.001).Highest level of physical inactivity is seen in HIC,which then gradually declines to LIC(17%).Tobacco prevalence in LIC is almost less than half of that in HIC and UMIC(HIC/LIC:t=7.2,p<0.0001).There is a gradual decline in the implementation of“best buys”from HIC to LIC.Conclusion:Wealthier countries have better implementation of the WHO NCD prevention strategy.展开更多
Objective:The objective of this study was to expand the evidence base on the prevalence of risk factors for the main noncommunicable diseases(such as diabetes mellitus,blood pressure,and obesity)among rural women in Y...Objective:The objective of this study was to expand the evidence base on the prevalence of risk factors for the main noncommunicable diseases(such as diabetes mellitus,blood pressure,and obesity)among rural women in Yemen.Methods:A descriptive cross-sectional study was conducted among 450 rural women in the age range from 18 to 60 years who presented in the targeted health centers of Sana’a and Al-Mah-weet governorates during the time of the study.Data were collected by a structured questionnaire developed as per World Health Organization STEPS guidelines.Body mass index,blood pressure,and biochemical measurements of fasting blood glucose were recorded.Results:Ninety-four percent of the respondents were physically inactive.Only 3.5% of re-spondents were smokers,while 66.3% were qat chewers.Forty-seven percent watched TV.Thirty-nine percent of respondents ate vegetables daily,while 19.5% consumed fruits daily.Among the respondents,31.3% were obese,15.0% were hypertensive,and 7.8% had diabetes mellitus.Age group,marital status,and education level were significantly associated with obesity,blood pres-sure,and diabetes mellitus.There were significant associations between obesity and blood pres-sure,as well as between blood pressure and diabetes mellitus.Conclusion:Frequent campaigns and educational programs are to be encouraged for the adoption of healthy lifestyle practices and health promotion.展开更多
Various inflammatory stimuli are able to modify or even"re-program"the mitochondrial metabolism that results in generation of reactive oxygen species.In noncommunicable chronic diseases such as atheroscleros...Various inflammatory stimuli are able to modify or even"re-program"the mitochondrial metabolism that results in generation of reactive oxygen species.In noncommunicable chronic diseases such as atherosclerosis and other cardiovascular pathologies,type 2 diabetes and metabolic syndrome,these modifications become systemic and are characterized by chronic inflammation and,in particular,"neuroinflammation"in the central nervous system.The processes associated with chronic inflammation are frequently grouped into"vicious circles"which are able to stimulate each other constantly amplifying the pathological events.These circles are evidently observed in Alzheimer's disease,atherosclerosis,type 2 diabetes,metabolic syndrome and,possibly,other associated pathologies.Furthermore,chronic inflammation in peripheral tissues is frequently concomitant to Alzheimer's disease.This is supposedly associated with some common genetic polymorphisms,for example,Apolipoprotein-Eε4 allele carriers with Alzheimer's disease can also develop atherosclerosis.Notably,in the transgenic mice expressing the recombinant mitochondria targeted catalase,that removes hydrogen peroxide from mitochondria,demonstrates the significant pathology amelioration and health improvements.In addition,the beneficial effects of some natural products from the xanthophyll family,astaxanthin and fucoxanthin,which are able to target the reactive oxygen species at cellular or mitochondrial membranes,have been demonstrated in both animal and human studies.We propose that the normalization of mitochondrial functions could play a key role in the treatment of neurodegenerative disorders and other noncommunicable diseases associated with chronic inflammation in ageing.Furthermore,some prospective drugs based on mitochondria targeted catalase or xanthophylls could be used as an effective treatment of these pathologies,especially at early stages of their development.展开更多
Objective This study examined vegetable and fruit （VF） consumption rate and its associated factors among Chinese adults. Methods Nationally representative data from the 2013 China Chronic Disease Surveillance survey...Objective This study examined vegetable and fruit （VF） consumption rate and its associated factors among Chinese adults. Methods Nationally representative data from the 2013 China Chronic Disease Surveillance survey were used. Dietary intake data, including VF consumption during the last 12 months, were collected. All analyses were weighted to obtain nationally representative estimates. Associations between VF consumption and other factors （e.g., meal frequency and physical activity） were examined through logistic regression analysis. Results The average fruit consumption was 102.3 g/day （95% CI： 97.0-107.6） and the average vegetable consumption was 350.6 g/day （95% CI： 339.3-361.8）. Over half （53.2%, 95% CI： 50.9-55.4） of Chinese adults met the VF consumption of 400 g/day recommended by the World Health Organization （WHO）. Rural residents had a higher prevalence of low VF consumption rate than urban residents [49.20% （95% CI： 46.2%-52.2%） vs. 44.0% （95% CI： 41.7%-46.3%） P 〈 0.01]. Old age （OR = 1.01, 95% CI： 1.00-1.01）, low educational level, low income, minority ethnicity （OR = 1.41, 95% CI： 1.15-1.74）, underweight （OR = 1.17, 95% CI： 1.03-1.33）, single marital status （OR = 1.20, 95% CI： 1.08-1.33）, low health literacy, irregular breakfast （OR = 1.20, 95% CI： 1.04-1.38） or lunch （OR = 1.58, 95% CI： 1.26-1.99） habits, and no leisure-time physical activity were associated with low VF consumption. Conclusion Only half of Chinese adults met the VF consumption recommended by the WHO. Low socio-economic status, irregular diet, and poor health literacy were likely associated with low VF consumption. National efforts and programs are needed to promote VF consumption.展开更多
AIM To evaluate the impact of sepsis and non-communicable diseases(NCDs) on the outcome of decompensated chronic liver disease(CLD) patients.METHODSIn this cross-sectional study, medical records of patients with CLD a...AIM To evaluate the impact of sepsis and non-communicable diseases(NCDs) on the outcome of decompensated chronic liver disease(CLD) patients.METHODSIn this cross-sectional study, medical records of patients with CLD admitted to the Gastroenterology unit at the Aga Khan University Hospital were reviewed.Patients older than 18 years with decompensation of CLD(i.e., jaundice, ascites,encephalopathy, and/or upper gastrointestinal bleed) as the primary reason for admission were included, while those who were admitted for reasons other than decompensation of CLD were excluded. Each patient was followed for 6 wk after index admission to assess mortality, prolonged hospital stay(> 5 d), and early readmission(within 7 d).RESULTS A total of 399 patients were enrolled. The mean age was 54.3 ± 11.7 years and64.6%(n = 258) were male. Six-week mortality was 13%(n = 52). Prolonged hospital stay and readmission were present in 18%(n = 72) and 7%(n = 28) of patients, respectively. NCDs were found in 47.4%(n = 189) of patients. Acute kidney injury, sepsis, and non-ST elevation myocardial infarction were found in41%(n = 165), 17.5%(n = 70), and 1.75%(n = 7) of patients, respectively. Upon multivariate analysis, acute kidney injury, non-ST elevation myocardial infarction, sepsis, and coagulopathy were found to be statistically significant predictors of mortality. While chronic kidney disease(CKD), low albumin, and high Model for End-Stage Liver Disease(MELD)-Na score were found to be statistically significant predictors of morbidity. Addition of sepsis in conventionalMELD score predicted mortality even better than MELD-Na(area under receiver operating characteristic: 0.735 vs 0.686; P < 0.001). Among NCDs, CKD was found to increase morbidity independently.CONCLUSION Addition of sepsis improved the predictability of MELD score as a prognostic marker for mortality in patients with CLD. Presence of CKD increases the morbidity of patients with CLD.展开更多
Background:Understanding factors influencing adolescents’ sport/exercise participation(S/EP) is vital to developing effective interventions,but currently,evidence from less developed countries is limited.The purpose ...Background:Understanding factors influencing adolescents’ sport/exercise participation(S/EP) is vital to developing effective interventions,but currently,evidence from less developed countries is limited.The purpose of this study was to examine correlates of S/EP across individual,interpersonal,and environmental levels in a nationally representative sample of Thai adolescents.Methods:Data from 4617 Thai adolescents aged 14-17 years old were obtained from recruited schools across Thailand.Data on S/EP(outcome variable),and psychosocial,home,and community environment covariates were collected from individual adolescents using the Thailand Physical Activity Children Survey,Student Questionnaire.School environmental data were collected at the school level using a School Built Environment Audit.Hierarchical regressions taking into account school clustering effects were applied for data analysis.Results:At the individual level,age and body mass index were independently and strongly correlated with S/EP.Adolescents with high preference for physical activity(PA)(odd ratio(OR)=1.71,p <0.001) and at least a moderate level of self-efficacy(OR=1.33,p=0.001) were more likely to have high S/EP.At the interpersonal level,adolescents whose parents joined their sports/exercise at least 1-2 times/week(OR=1.36,p=0.003) received>3 types of parental support(OR=1.43,p=0.005) and who received siblings’(OR=1.26,p=0.004) and friends’(OR=1.99,p <0.001) support had a greater chance of high S/EP.At the environmental level,adolescents’ S/EP was greater when there were at least 3-4 pieces of home sport/exercise equipment(OR=2.77,p=0.003),grass areas at school(OR=1.56,p <0.001),and at least 1-2 PA facilities in the community(OR=1.30,p=0.009).Conclusion:Multiple factors at different levels within an ecological framework influencing Thai adolescents’ S/EP were generally similar to those found in developed countries,despite some differences.For those interested in promoting and supporting Thai adolescents’ engagement in sports/exercise,further exploration of the influence of self-efficacy and attitude toward PA is required at the individual level;parental and peer support at the interpersonal level;and home sport equipment,school grass areas,and neighborhood PA facilities at the environment level.展开更多
Background: The recent surge in economic development in Myanmar will also contribute to accelerating the health burden shift from acute infectious to chronic non-communicable diseases (NCDs) across the country. With j...Background: The recent surge in economic development in Myanmar will also contribute to accelerating the health burden shift from acute infectious to chronic non-communicable diseases (NCDs) across the country. With just 11 years to achieve its goal of universal health coverage by the year 2030, significant efforts will be needed to quantify the scale of the burden facing decision-makers about health system strengthening and redevelopment. Convergence of the health systems will be an additional challenge in Myanmar. Methods: Results from a WHO study in 2009 and 2014, combined with data from the 2016 Global Burden of Disease Study, were compiled and analysed for Myanmar to assess the levels and trends of selected NCDs and NCD risk factors. Results: The prevalence of major NCDs in Myanmar are in general higher than global and regional averages, with a significant increase in diabetes mellitus and chronic obstructive pulmonary diseases in the last 25 years. Major NCD risk factors in Myanmar include smoking, use of smokeless tobacco, alcohol consumption among men, low level of fruit and vegetable consumption, hypertension, and emerging of overweight and obesity, especially among women. Tobacco use increased in both sexes between 2009 and 2014, but only significantly in men. Rates of hypertension increased for both men and women, including those currently on medications—suggesting a need for better treatment regimens. Overweight and obesity rates increased in both men and women, although the increase in obesity for men was not significant. Alcohol consumption results were mixed—with lower levels of high level drinking in men, but generally increased consumption by women. Intake of fruit and vegetables increased slightly between 2009 and 2014 and rates of high levels of physical activity also increased. Diabetes prevalence rates increased significantly in women (X2 = 11.3;p = 0.01) and men (X2 = 9.6;p = 0.02) between 2009 and 2014. Conclusions: Improved awareness of risk factors, coupled with early diagnosis and effective treatment of conditions and risks, is paramount to keeping the population healthy and economically active, and maintaining health care costs. Proven cost-effective interventions to prevent and control NCD-related risk factors, notably increasing tobacco taxes, should be endorsed and implemented in the population. Inaction could hamper the country’s effort to achieve universal health coverage by the year 2030.展开更多
Translational research is a broad field of medicine with several key phases moving from scientific discovery to bench research and the hospital bedside,followed by evidence-based practice and population-level policy a...Translational research is a broad field of medicine with several key phases moving from scientific discovery to bench research and the hospital bedside,followed by evidence-based practice and population-level policy and programming. Understanding these phases is crucial when it comes to preventing and treating illness,especially in global health. Communities around the world struggle with a variety of health problems that are at some times similar and at others quite different. Three major world health issues help to outline the phases of translational research:vaccines,human immunodeficiency virus and acquired immunodeficiencysyndrome,and non-communicable diseases. Laboratory research has excelled in many of these areas and is struggling in a few. Where successful therapies have been discovered there are often problems with appropriate use or dissemination to groups in need. Also,many diseases would be better prevented from a population health approach. This review highlights successes and struggles in the arena of global health,from smallpox eradication to the impending epidemic of cardiovascular disease,in an attempt to illustrate of the various phases of translational research.展开更多
Purpose:This study aims to examine the level of behavioral health integration in primary care clinics among patients with hypertension and type 2 diabetes in Chiang Mai,Thailand.It also aims to explore the provider pe...Purpose:This study aims to examine the level of behavioral health integration in primary care clinics among patients with hypertension and type 2 diabetes in Chiang Mai,Thailand.It also aims to explore the provider perceived prevalence of behavioral problems and need for an expert behavioral health consultant on the primary care team and the risk and protective factors of the patients’psychological and cardio-metabolic health outcomes.Methodology:Using survey data between 2017 and 2018 regarding the level of integration as measured by a Practice Integration Profile,provider ratings of prevalence and need based on a Provider Survey,and patient lifestyle and behavioral problems with a Health Risk Assessment in six primary health care settings in Chiang Mai,Thailand(n=335).We conducted ordinary least squares regressions to explore the relationship between each of the patient psychological and cardio-metabolic health outcomes and physical,mental health and substance abuse variables while controlling for the demographics.Results:The results showed overall high levels of integration,but significant variability across clinics.Providers rated prevalence of health risk and need for a Behavioral Health Consultant as moderate.Results of the patient health risk assessment were variable,with some problems high severity,others low.Conclusion:The results reflect a need for integrated behavioral health into the health care system in Thailand especially for those who are in the chronic illness condition.Recommendations for future study include an evaluation of the translation quality and validity and reliability of the study measures under the Thai context.This study fills the research gap of lacking research on the level of integrated care in clinics in Thailand.展开更多
文摘BACKGROUND The prevalence and severity of noncommunicable chronic diseases(NCDs)among Chinese residents have been increasing with mental health emerging as a critical challenge in disease management.AIM To examine the interactions between depression,anxiety symptoms,and related factors,and to identify key factors in the Chinese population with NCDs.METHODS Data from the Psychology and Behavior Investigation of Chinese Residents were used in a cross-sectional survey of 6182 individuals with NCDs.This study measured depression and anxiety symptoms as well as their influencing factorsincluding social environments,individual behaviors and lifestyles,and subjective indicators.A network analysis approach was used for data assessment.RESULTS Network analysis demonstrated that several central factors(media exposure,family health,problematic internet use,suboptimal health status,intimate relationship violence,tired or little energy,and nervousness/anxious/on edge)and bridge factors(media exposure,problematic internet use,intimate partner violence,health literacy,and suboptimal health status)that significantly influenced the co-occurrence and interconnectedness of depression and anxiety symptoms.Additionally,gender,ethnicity,residency,and living status did not significantly influence the overall network strength.CONCLUSION Depression and anxiety are prevalent among the Chinese population with NCDs.Effective interventions should focus on managing key symptoms,promoting correct media use for health information,and fostering healthier family relationships.
文摘The purpose of this article is to briefly introduce the status and challenges of major noncommunicable diseases （mNCDs）, which include cardiovascular disease, diabetes and cancer, as well as related risk factors, such as environmental pollution, smoking, obesity and sleep disorders. ＂S-E-E-D＂ rules or the strategies of ＂S-E-E-D＂ intervention （SEEDi） consist of four core healthy elements： sleep, emotion, exercise and diet. The history of SEEDi1.0-3.0 is also introduced, which includes versions 1.0, 1.5, 2.0 and 3.0 of the program. These guidelines are suitable for prevention and control of mNCDs. Not only the ＂Healthy China＂ initiated in China＇s ＂13th Five-year Plan,＂ but also the ＂Healthy World＂ philosophy needs SEEDi1.0-3.0 strategies for control of mNCDs.
文摘High blood pressure and other non-communicable diseases associated with excessive salt/sodium consumption represent a major challenge to the health of the world’s population. Consumption is a human behavior that is usually influenced by significant factors, internal and external to people. The design of a national social marketing intervention is described. The whole process was developed by a national interdisciplinary team over the course of a decade (2011-2022). Its purpose is to promote changes in this behavior, through gradual reduction of salt/sodium consumption in the target populations of Costa Rica, for the prevention and control of associated diseases. The process includes four phases: research, situation analysis, creation of a proposal for the social marketing strategy, and implementation and evaluation. Last phase was not developed by the research team. The main inputs used to design this intervention were the data generated in three qualitative researchers carried out by the national work team and the social marketing regional plan for salt consumption reduction in Latin America. By analyzing these research data, marketing mix components were determined for designing the intervention. The marketing strategy is promotional and is based on encouraging a natural diet with less sodium using natural seasonings and adding less discretional salt and industrialized products high in sodium, in the preparation of food and dishes. The primary key audience is the mother of the school-aged child, and the secondary is the adult caregivers of this child. It is expected that in the short term, health promoters from different government and non-state sectors will contribute to the implementation of the national social marketing plan, to achieve, in the medium or long term, a consumption that approaches five grams of salt per person per day. This plan is a country initiative to position the value of a natural diet with less sodium and to contribute to the prevention and treatment of HT and NCD associated diseases.
基金National Natural Science Foundation of China,Grant/Award Numbers:81872692,82073642。
文摘1|BACKGROUND Noncommunicable diseases(NCDs)are a significant public concern,greatly impacting the economic and social development in China.In 2019,NCDs accounted for a staggering 88.5%of total deaths in China,with cardiovas-cular diseases,cancer,chronic respiratory diseases,and diabetes—the four major chronic diseases—contributing to a premature mortality rate of 16.5%[1].The complexity of NCDs arises from the involvement of multiple genetic and environmental factors that interact in intricate ways.The complexity is characterized by a multitude of interactions among genes,proteins,and metabolic path-ways throughout the various stages of life.
文摘In May 2022,the 75th World Health Assembly recognized the need to accelerate national responses to the growing burden of noncommunicable diseases(NCDs)to achieve the goals of the Global Action Plan(GAP)for the Prevention and Control of NCDs.To facilitate this,an implementation roadmap was adopted that urges countries to prioritize the implementation of NCD interventions that are most appropriate to their specific local and regional context.The roadmap will act as an overarching guide for countries to tackle NCDs via three approaches:(i)Accelerate national responses based on local NCD epidemiology,risk factors and identified barriers and enablers;(ii)Prioritize and scale up the implementation of most impactful and feasible interventions according to the local context;and(iii)Ensure timely,reliable and sustained national data on NCD risk factors and mortality for data driven actions and to strengthen accountability[1].
基金The National Nutrition Services(NNS),Institute of Public Health Nutrition,Ministry of Health and Family Welfare,Bangladesh,Grant/Award Numbers:Memo:45.165.032.01.00.003.2016-325Date:10-12-2017,45.165.032.01.00.003.2016-325+1 种基金National Institute for Health Research(NIHR),Grant/Award Number:16/136/68Wellcome Trust,Grant/Award Number:212945/Z/18/Z。
文摘Background:Noncommunicable diseases(NCDs)are public health threats globally and recognized impediments to socioeconomic development.This study aimed to identify the prevalence and clustering of NCDs risk factors among Bangladeshi men and women aged 20-59 years using nationally representative data.Methods:This study was conducted in 82 rural,nonslum urban,and slum clusters across all eight administrative divisions of Bangladesh using multistage cluster sampling.A total of 4917 men and 4905 women aged 20-59 years were included in the study.Descriptive analyses were performed to report the prevalence and distribution of behavioral and clinical risk factors.Multivariable binary logistic regression was performed to identify factors associated with the coexistence of three or more NCD risk factors.Results:The prevalence of tobacco use(any form),insufficient physical activity,inadequate fruit and vegetable consumption,overweight and obesity,and central obesity were 38.3%,13.6%,87.1%,42.3%,and 36.0%,respectively.Furthermore,21.9%and 4.9%participants had hypertension and self-reported diabetes,respectively.Regarding the clustering of risk factors,37.1%men and 50.8%women had at least three NCD risk factors.Only 3.0%men and 1.8%women reported no NCD risk factors.Age,place of residence,education,and wealth status were associated with the presence of at least three risk factors for both sexes.Conclusion:Since a large proportion of Bangladeshi 20-59 years old population had multiple risk factors,population-based programs with multisectoral approaches are essential to reduce NCDs among Bangladeshi women and men.
文摘Background Noncommunicable diseases(NCDs)are the main reasons of mortality worldwide.One of every two person is dying due to NCDs in Afghanistan.International policy actors,mainly the World Health Organization(WHO),published several reports and declarations on controlling and preventing NCDs.This study aimed to provide a situation for governance of NCDs in Afghanistan and proper solutions for identified challenges.Methods We conducted qualitative research utilizing interpretive phenomenology.A self-developed questionnaire was developed to conduct the semi-structured interviews with 39 experts from Afghanistan.The results were analyzed using a deductive framework analysis.Six building block framework of health system developed by the WHO was used as predefined framework for this study.Results The governance building block of health system consists of five subthemes including policy making,planning,organizing,stewardship,and control.We identified main strengths,weaknesses,opportunities,and challenges for these subthemes.The experts also provided key recommendations to address the challenges.Conclusions Management of NCDs is a neglected part of the health system in Afghanistan.Strengthening evidence-based policy making with technical and indigenous planning,establishing responsive units with adequate financial and human resources within different ministries to address“health in all policies”concept,passing and implementing national laws and regulations to support national strategies for prevention and control of NCDs,and establishing decentralized monitoring systems to control the implementation of these strategies are the main recommendations of this study.Local government and international policy actors should invest and support the development of a multisectoral coordination system at national level for Afghanistan.
文摘Background:Disease epidemiology encompasses a wide range of health conditions,divided into communicable and noncommunicable diseases.Aim and Objective:This systematic review investigates the intricate connection between genetic susceptibility and disease development within these categories.Understanding genetic factors is crucial for improving prevention,diagnosis,and treatment strategies.The central research question is as follows:Which genes are linked to susceptibility to communicable and noncommunicable diseases,and how do these genetic elements affect susceptibility?We hypothesize that an exhaustive analysis of the literature will reveal numerous genes associated with both types of diseases,revealing the complex genetic landscape influencing susceptibility.Methodology:This systematic review follows a rigorous methodology,including comprehensive search strategies,well-defined inclusion and exclusion criteria,publication bias assessment,data extraction,quality evaluation,and data synthesis,adhering to PRISMA(Preferred Reporting Items for Systematic Reviews and Meta-Analyses)guidelines to ensure transparency and ethical presentation.Several databases,including PubMed,Embase,Springer Nature,AJOL,CrossRef,Scopus,and Web of Science,were systematically searched to retrieve published articles.Findings:In communicable diseases,the genetic factors influencing susceptibility extend beyond well-established genes,warranting further investigation under conditions such as COVID-19,HIV,tuberculosis,and hepatitis B.Noncommunicable diseases,such as cardiovascular diseases,cancer,neurological disorders,and metabolic disorders,offer promising avenues for exploring additional genetic variations.Research gaps include understanding the functional impact of the identified polymorphisms,their interaction with environmental factors,and their implications for rare diseases.Conclusion:Genome-wide association studies and gene editing therapies have the potential to expand our understanding and therapeutic options for genetically based diseases.This comprehensive review contributes to the evolving landscape of genetic susceptibility and its implications for public health and personalized medicine.
文摘Chronic diseases,or NCDs(noncommunicable diseases),constitute a major global health challenge,causing millions of deaths and imposing substantial economic burdens annually.This paper introduces the Health Score,a comprehensive framework for assessing chronic disease risk by integrating diverse determinants of health,including social,economic,environmental,behavioral,treatment,culture,and nature factors.The Health Score,ranging from 0 to 850,quantifies indivi dual and population-level health risks while identifying protective factors through a structured methodology that supports targeted interventions at individual,corporate,and community scales.The paper highlights the rising prevalence of chronic diseases in the United States,projecting that nearly half of the population will be affected by 2030,alongside a global economic burden expected to reach trillions of dollars.Existing surveillance tools,such as the CDS(Chronic Disease Score)and CDIs(Chronic Disease Indicators),are examined for their roles in monitoring health disparities.The Health Score advances a holistic,proactive approach,emphasizing lifestyle modifications,equitable healthcare access,economic opportunities,social support,nature exposure,cu ltural awareness,and community engagement.By elucidating the complex interplay of health determinants,this framework equips stakeholders with actionable insights to implement effective prevention strategies,ultimately fostering healthier,more resi lient populations.
文摘Background:Afghanistan is suffering from 40-year chronic conflicts,displacement,and demolition of its infrastructure.Afghanistan mortality survey 2010 shows nearly 46%of all deaths in the country were attributed to noncommunicable diseases(NCDs).In this study,we aimed to understand the differences in mortality and premature death due to NCDs by sex and the trend for the next 8 years.Methods:We applied trend analysis using the secondary data from the Institute for Health Metrics and Evaluation,Global Burden of Diseases 2019.The information on NCD mortality,NCD deaths attributed to its risk factors,NCD percent of total years lived with disability(YLDs)attribution to each risk factor extracted from this database from 2008 to 2019.We investigated the trend from 2008 to 2019 for the mentioned factors and then forecast their trends until 2030.Results:Our study shows that Afghanistan has had an increasing death number due to NCDs from 2008 to 2019(50%for both sexes)and this will reach nearly 54%by 2030.Currently,half of NCDs deaths are premature in Afghanistan.The mortality rate and prevalence of risk factors are higher among women.More than 70%of YLDs will be due to NCDs in Afghanistan till 2030.Five risk factors including high systolic blood pressure(28.3%),high body mass index(23.4%),high blood glucose(20.6%),high low-density lipoprotein cholesterol(16.3%),and smoking(12.3%)will have the highest contribution to NCDs death in 2030,respectively.Conclusions:In general,our study indicates that without any specific intervention to address NCDs in Afghanistan,not only the Sustainable Development Goal target for NCDs will not be met,but an increase in almost all risk factors prevalence,as well as NCD mortality,will be seen in Afghanistan.
文摘Background:Noncommunicable diseases(NCDs)are the leading cause of morbidity and mortality worldwide.The aim of this study was to determine the prevalence of NCDs among the population of Cyprus and to identify the distribution of the socioeconomic and demographic determinants among individuals with the most frequent NCDs.Methods:A cross-sectional study was conducted using stratified sampling.Socioeconomic and demographic characteristics and the presence of NCDs were collected through a standardized questionnaire.The diseases were classified using the 10th revision of the International Classification of Diseases(ICD-10).Results:In total,1140 individuals participated in the study,among whom 590(51.7%)had at least one chronic disease.The most prevalent NCDs were hyperlipidemia(17.4%),hypertension(12.9%),and thyroid diseases(8.4%).We identified more males than females with hyperlipidemia aged 25–44 years old and>65 years old(p=0.024),more males compared to females with hypertension(p=0.001)and more females compared to males with thyroid diseases(p<0.001).Individuals with hypertension and hyperlipidemia were more likely to be married,to have completed a higher education,and to have a high annual income.Discussion:In Cyprus,the majority of the general population had at least one NCD.Hyperlipidemia,hypertension,and thyroid disease are relatively common,even at younger ages,highlighting the need for the development of public health programs aimed at addressing and preventing NCDs.
文摘Background:Noncommunicable diseases(NCDs)place a heavy burden on populations globally and in particular,on lower-income countries(LIC).WHO identified a package of 16“best buy”lifestyle and management interventions that are cost-effective and applicable in all settings.The purpose of this study was to evaluate and compare NCD risk factors in all WHO countries and make preliminary assessment of“best buy”interventions.Methods:Risk factors estimation was made in 188 countries.NCD attributable“best buys”concern tobacco use,unhealthy diet,physical inactivity,and harmful use of alcohol.Management issues are based on the availability of the national NCD guidelines and provision of drug therapy.Results:Every fourth adult in high-income countries(HIC)has raised blood pressure(RBP).Prevalence of RBP in lower-middle-income countries(LMIC)and LIC is 22%–23%(HIC/LMIC:t=3.12,p<0.01).Prevalence of diabetes in LIC is less than half of that in HIC and upper-middle-income countries(UMIC)UMIC/LIC:t=8.37,p<0.001.Obesity prevalence is gradually decreasing from HIC to LIC(HIC/LIC:t=11.48,p<0.001).Highest level of physical inactivity is seen in HIC,which then gradually declines to LIC(17%).Tobacco prevalence in LIC is almost less than half of that in HIC and UMIC(HIC/LIC:t=7.2,p<0.0001).There is a gradual decline in the implementation of“best buys”from HIC to LIC.Conclusion:Wealthier countries have better implementation of the WHO NCD prevention strategy.
文摘Objective:The objective of this study was to expand the evidence base on the prevalence of risk factors for the main noncommunicable diseases(such as diabetes mellitus,blood pressure,and obesity)among rural women in Yemen.Methods:A descriptive cross-sectional study was conducted among 450 rural women in the age range from 18 to 60 years who presented in the targeted health centers of Sana’a and Al-Mah-weet governorates during the time of the study.Data were collected by a structured questionnaire developed as per World Health Organization STEPS guidelines.Body mass index,blood pressure,and biochemical measurements of fasting blood glucose were recorded.Results:Ninety-four percent of the respondents were physically inactive.Only 3.5% of re-spondents were smokers,while 66.3% were qat chewers.Forty-seven percent watched TV.Thirty-nine percent of respondents ate vegetables daily,while 19.5% consumed fruits daily.Among the respondents,31.3% were obese,15.0% were hypertensive,and 7.8% had diabetes mellitus.Age group,marital status,and education level were significantly associated with obesity,blood pres-sure,and diabetes mellitus.There were significant associations between obesity and blood pres-sure,as well as between blood pressure and diabetes mellitus.Conclusion:Frequent campaigns and educational programs are to be encouraged for the adoption of healthy lifestyle practices and health promotion.
文摘Various inflammatory stimuli are able to modify or even"re-program"the mitochondrial metabolism that results in generation of reactive oxygen species.In noncommunicable chronic diseases such as atherosclerosis and other cardiovascular pathologies,type 2 diabetes and metabolic syndrome,these modifications become systemic and are characterized by chronic inflammation and,in particular,"neuroinflammation"in the central nervous system.The processes associated with chronic inflammation are frequently grouped into"vicious circles"which are able to stimulate each other constantly amplifying the pathological events.These circles are evidently observed in Alzheimer's disease,atherosclerosis,type 2 diabetes,metabolic syndrome and,possibly,other associated pathologies.Furthermore,chronic inflammation in peripheral tissues is frequently concomitant to Alzheimer's disease.This is supposedly associated with some common genetic polymorphisms,for example,Apolipoprotein-Eε4 allele carriers with Alzheimer's disease can also develop atherosclerosis.Notably,in the transgenic mice expressing the recombinant mitochondria targeted catalase,that removes hydrogen peroxide from mitochondria,demonstrates the significant pathology amelioration and health improvements.In addition,the beneficial effects of some natural products from the xanthophyll family,astaxanthin and fucoxanthin,which are able to target the reactive oxygen species at cellular or mitochondrial membranes,have been demonstrated in both animal and human studies.We propose that the normalization of mitochondrial functions could play a key role in the treatment of neurodegenerative disorders and other noncommunicable diseases associated with chronic inflammation in ageing.Furthermore,some prospective drugs based on mitochondria targeted catalase or xanthophylls could be used as an effective treatment of these pathologies,especially at early stages of their development.
基金founded by the Central Finance of the Chinese Government and the National Natural Science Foundation of China[grant number 81202287]
文摘Objective This study examined vegetable and fruit （VF） consumption rate and its associated factors among Chinese adults. Methods Nationally representative data from the 2013 China Chronic Disease Surveillance survey were used. Dietary intake data, including VF consumption during the last 12 months, were collected. All analyses were weighted to obtain nationally representative estimates. Associations between VF consumption and other factors （e.g., meal frequency and physical activity） were examined through logistic regression analysis. Results The average fruit consumption was 102.3 g/day （95% CI： 97.0-107.6） and the average vegetable consumption was 350.6 g/day （95% CI： 339.3-361.8）. Over half （53.2%, 95% CI： 50.9-55.4） of Chinese adults met the VF consumption of 400 g/day recommended by the World Health Organization （WHO）. Rural residents had a higher prevalence of low VF consumption rate than urban residents [49.20% （95% CI： 46.2%-52.2%） vs. 44.0% （95% CI： 41.7%-46.3%） P 〈 0.01]. Old age （OR = 1.01, 95% CI： 1.00-1.01）, low educational level, low income, minority ethnicity （OR = 1.41, 95% CI： 1.15-1.74）, underweight （OR = 1.17, 95% CI： 1.03-1.33）, single marital status （OR = 1.20, 95% CI： 1.08-1.33）, low health literacy, irregular breakfast （OR = 1.20, 95% CI： 1.04-1.38） or lunch （OR = 1.58, 95% CI： 1.26-1.99） habits, and no leisure-time physical activity were associated with low VF consumption. Conclusion Only half of Chinese adults met the VF consumption recommended by the WHO. Low socio-economic status, irregular diet, and poor health literacy were likely associated with low VF consumption. National efforts and programs are needed to promote VF consumption.
文摘AIM To evaluate the impact of sepsis and non-communicable diseases(NCDs) on the outcome of decompensated chronic liver disease(CLD) patients.METHODSIn this cross-sectional study, medical records of patients with CLD admitted to the Gastroenterology unit at the Aga Khan University Hospital were reviewed.Patients older than 18 years with decompensation of CLD(i.e., jaundice, ascites,encephalopathy, and/or upper gastrointestinal bleed) as the primary reason for admission were included, while those who were admitted for reasons other than decompensation of CLD were excluded. Each patient was followed for 6 wk after index admission to assess mortality, prolonged hospital stay(> 5 d), and early readmission(within 7 d).RESULTS A total of 399 patients were enrolled. The mean age was 54.3 ± 11.7 years and64.6%(n = 258) were male. Six-week mortality was 13%(n = 52). Prolonged hospital stay and readmission were present in 18%(n = 72) and 7%(n = 28) of patients, respectively. NCDs were found in 47.4%(n = 189) of patients. Acute kidney injury, sepsis, and non-ST elevation myocardial infarction were found in41%(n = 165), 17.5%(n = 70), and 1.75%(n = 7) of patients, respectively. Upon multivariate analysis, acute kidney injury, non-ST elevation myocardial infarction, sepsis, and coagulopathy were found to be statistically significant predictors of mortality. While chronic kidney disease(CKD), low albumin, and high Model for End-Stage Liver Disease(MELD)-Na score were found to be statistically significant predictors of morbidity. Addition of sepsis in conventionalMELD score predicted mortality even better than MELD-Na(area under receiver operating characteristic: 0.735 vs 0.686; P < 0.001). Among NCDs, CKD was found to increase morbidity independently.CONCLUSION Addition of sepsis improved the predictability of MELD score as a prognostic marker for mortality in patients with CLD. Presence of CKD increases the morbidity of patients with CLD.
基金the Thai Health Promotion Foundation for research funding。
文摘Background:Understanding factors influencing adolescents’ sport/exercise participation(S/EP) is vital to developing effective interventions,but currently,evidence from less developed countries is limited.The purpose of this study was to examine correlates of S/EP across individual,interpersonal,and environmental levels in a nationally representative sample of Thai adolescents.Methods:Data from 4617 Thai adolescents aged 14-17 years old were obtained from recruited schools across Thailand.Data on S/EP(outcome variable),and psychosocial,home,and community environment covariates were collected from individual adolescents using the Thailand Physical Activity Children Survey,Student Questionnaire.School environmental data were collected at the school level using a School Built Environment Audit.Hierarchical regressions taking into account school clustering effects were applied for data analysis.Results:At the individual level,age and body mass index were independently and strongly correlated with S/EP.Adolescents with high preference for physical activity(PA)(odd ratio(OR)=1.71,p <0.001) and at least a moderate level of self-efficacy(OR=1.33,p=0.001) were more likely to have high S/EP.At the interpersonal level,adolescents whose parents joined their sports/exercise at least 1-2 times/week(OR=1.36,p=0.003) received>3 types of parental support(OR=1.43,p=0.005) and who received siblings’(OR=1.26,p=0.004) and friends’(OR=1.99,p <0.001) support had a greater chance of high S/EP.At the environmental level,adolescents’ S/EP was greater when there were at least 3-4 pieces of home sport/exercise equipment(OR=2.77,p=0.003),grass areas at school(OR=1.56,p <0.001),and at least 1-2 PA facilities in the community(OR=1.30,p=0.009).Conclusion:Multiple factors at different levels within an ecological framework influencing Thai adolescents’ S/EP were generally similar to those found in developed countries,despite some differences.For those interested in promoting and supporting Thai adolescents’ engagement in sports/exercise,further exploration of the influence of self-efficacy and attitude toward PA is required at the individual level;parental and peer support at the interpersonal level;and home sport equipment,school grass areas,and neighborhood PA facilities at the environment level.
文摘Background: The recent surge in economic development in Myanmar will also contribute to accelerating the health burden shift from acute infectious to chronic non-communicable diseases (NCDs) across the country. With just 11 years to achieve its goal of universal health coverage by the year 2030, significant efforts will be needed to quantify the scale of the burden facing decision-makers about health system strengthening and redevelopment. Convergence of the health systems will be an additional challenge in Myanmar. Methods: Results from a WHO study in 2009 and 2014, combined with data from the 2016 Global Burden of Disease Study, were compiled and analysed for Myanmar to assess the levels and trends of selected NCDs and NCD risk factors. Results: The prevalence of major NCDs in Myanmar are in general higher than global and regional averages, with a significant increase in diabetes mellitus and chronic obstructive pulmonary diseases in the last 25 years. Major NCD risk factors in Myanmar include smoking, use of smokeless tobacco, alcohol consumption among men, low level of fruit and vegetable consumption, hypertension, and emerging of overweight and obesity, especially among women. Tobacco use increased in both sexes between 2009 and 2014, but only significantly in men. Rates of hypertension increased for both men and women, including those currently on medications—suggesting a need for better treatment regimens. Overweight and obesity rates increased in both men and women, although the increase in obesity for men was not significant. Alcohol consumption results were mixed—with lower levels of high level drinking in men, but generally increased consumption by women. Intake of fruit and vegetables increased slightly between 2009 and 2014 and rates of high levels of physical activity also increased. Diabetes prevalence rates increased significantly in women (X2 = 11.3;p = 0.01) and men (X2 = 9.6;p = 0.02) between 2009 and 2014. Conclusions: Improved awareness of risk factors, coupled with early diagnosis and effective treatment of conditions and risks, is paramount to keeping the population healthy and economically active, and maintaining health care costs. Proven cost-effective interventions to prevent and control NCD-related risk factors, notably increasing tobacco taxes, should be endorsed and implemented in the population. Inaction could hamper the country’s effort to achieve universal health coverage by the year 2030.
文摘Translational research is a broad field of medicine with several key phases moving from scientific discovery to bench research and the hospital bedside,followed by evidence-based practice and population-level policy and programming. Understanding these phases is crucial when it comes to preventing and treating illness,especially in global health. Communities around the world struggle with a variety of health problems that are at some times similar and at others quite different. Three major world health issues help to outline the phases of translational research:vaccines,human immunodeficiency virus and acquired immunodeficiencysyndrome,and non-communicable diseases. Laboratory research has excelled in many of these areas and is struggling in a few. Where successful therapies have been discovered there are often problems with appropriate use or dissemination to groups in need. Also,many diseases would be better prevented from a population health approach. This review highlights successes and struggles in the arena of global health,from smallpox eradication to the impending epidemic of cardiovascular disease,in an attempt to illustrate of the various phases of translational research.
基金supported by USAID Global Development Research(GDR)Scholar grant.
文摘Purpose:This study aims to examine the level of behavioral health integration in primary care clinics among patients with hypertension and type 2 diabetes in Chiang Mai,Thailand.It also aims to explore the provider perceived prevalence of behavioral problems and need for an expert behavioral health consultant on the primary care team and the risk and protective factors of the patients’psychological and cardio-metabolic health outcomes.Methodology:Using survey data between 2017 and 2018 regarding the level of integration as measured by a Practice Integration Profile,provider ratings of prevalence and need based on a Provider Survey,and patient lifestyle and behavioral problems with a Health Risk Assessment in six primary health care settings in Chiang Mai,Thailand(n=335).We conducted ordinary least squares regressions to explore the relationship between each of the patient psychological and cardio-metabolic health outcomes and physical,mental health and substance abuse variables while controlling for the demographics.Results:The results showed overall high levels of integration,but significant variability across clinics.Providers rated prevalence of health risk and need for a Behavioral Health Consultant as moderate.Results of the patient health risk assessment were variable,with some problems high severity,others low.Conclusion:The results reflect a need for integrated behavioral health into the health care system in Thailand especially for those who are in the chronic illness condition.Recommendations for future study include an evaluation of the translation quality and validity and reliability of the study measures under the Thai context.This study fills the research gap of lacking research on the level of integrated care in clinics in Thailand.
